Provider Demographics
NPI:1427428069
Name:APPLIED PROTEOMICS, INC.
Entity type:Organization
Organization Name:APPLIED PROTEOMICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-999-2800
Mailing Address - Street 1:3545 JOHN HOPKINS CT
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1112
Mailing Address - Country:US
Mailing Address - Phone:858-999-2800
Mailing Address - Fax:858-202-6176
Practice Address - Street 1:3545 JOHN HOPKINS CT
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1112
Practice Address - Country:US
Practice Address - Phone:858-999-2800
Practice Address - Fax:858-202-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D2074504291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACLF 00345493OtherCA STATE LICENSE